Thoracic duct decompression and jugular vein banding-an effective treatment option for protein-losing enteropathy and plastic bronchitis in severe failing Fontan circulation: a case report

European Heart Journal. Case Reports
Christoph BauerGerald Tulzer

Abstract

Plastic bronchitis (PB) and protein-losing enteropathy (PLE) are devastating complications after Fontan palliation that lead to uncontrolled loss of protein-rich lymphatic fluid into extra lymphatic compartments. Decompression of the thoracic duct is a new treatment option that effectively restores lymphatic system integrity by redirecting lymphatic flow into the low-pressure levels of the common atrium. We report a patient with severe failing Fontan circulation where surgical thoracic duct decompression leads to resolution of PLE and PB symptoms but worsening hypoxaemia that could be managed with banding of internal jugular vein. Thoracic duct decompression in patients with failing Fontan circulation can be a simple and effective treatment for PLE and PB. Hypoxaemia may occur but can be managed with banding of internal jugular vein.

References

Aug 6, 2013·The Annals of Thoracic Surgery·Viktor Hraška
Apr 10, 2016·Seminars in Thoracic and Cardiovascular Surgery. Pediatric Cardiac Surgery Annual·Jack Rychik
May 24, 2016·The Annals of Thoracic Surgery·Marta AntónioJosé Fragata
Jun 18, 2017·Journal of the American College of Cardiology·Maxim ItkinYoav Dori
Jul 2, 2019·Circulation·Jack RychikUNKNOWN American Heart Association Council on Cardiovascular Disease in the Young and Council on Cardiovascular and Stroke Nursing
Aug 25, 2019·Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions·Christopher L SmithJonathan J Rome
Oct 10, 2019·Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions·Geert MaleuxMarc Gewillig

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Citations

Jun 13, 2021·Seminars in Thoracic and Cardiovascular Surgery. Pediatric Cardiac Surgery Annual·Chet R VillaDavid L S Morales
Jul 29, 2021·JTCVS Techniques·Viktor HraskaChristian Kreutzer

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